Case report demonstrates flagellate erythema onset after a low 30 mg bleomycin dose, highlighting the risk of cutaneous toxicity even at reduced exposure levels.
Flagellate erythema is a rare, distinctive dermatitis that may be the result of treatment with bleomycin or ingestion of shiitake mushrooms.It has also been associated with conditions such as systemic-onset juvenile idiopathic arthritis (Still disease) or dermatomyositis.We present a case of bleomycin-induced flagellate erythema that occurred at a cumulative dosing of 30 mg, which is less than what typically precipitates onset.Bleomycin-associated flagellate erythema is thought to occur due to the low levels of bleomycin hydrolase (BMH) in the skin.This condition is typically self-limiting, with the mainstays of treatment focusing on control of associated pruritus.In this case, improvement was observed at the two-month follow-up, with resolution of pruritus and characteristic progression to hyperpigmentation, which showed areas of fading at four months.
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Kirby et al. (2026) studied this question.
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